CPT code 48155 is for the surgical removal of the pancreas, a procedure often necessary for treating pancreatic diseases.
CPT code 48155 is for the surgical procedure involving the removal of the pancreas, also known as a pancreatectomy. This code is used to document and bill for the surgical intervention when a healthcare provider performs a complete or partial excision of the pancreas, which may be necessary due to conditions such as pancreatic cancer, chronic pancreatitis, or other pancreatic disorders.
For CPT code 48155, "Removal of pancreas," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or additional work involved in the removal of the pancreas.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. If the removal of the pancreas is performed along with other procedures, this modifier would be appropriate.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. If the removal of the pancreas is not completed as initially planned, this modifier would be used.
4. Modifier 53 - Discontinued Procedure: Applied when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be necessary if the removal of the pancreas is performed in conjunction with other distinct procedures.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. If two surgeons are involved in the removal of the pancreas, this modifier would be appropriate.
7. Modifier 66 - Surgical Team: Applied when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel. If the removal of the pancreas involves a surgical team, this modifier would be used.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure. If an assistant surgeon is necessary for the removal of the pancreas, this modifier would be appropriate.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon is required for a short duration during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the circumstances surrounding the procedure to ensure accurate billing and reimbursement.
CPT code 48155 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) in your region and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). It's important to verify coverage and reimbursement with your local MAC before submitting claims for this procedure.
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